King County Vital Statistics
Mailbox 359784
325 Ninth Ave
Seattle, WA 98104-2499
206-897-5100
To request this document in another format, call 1-800-525-0127.
Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected]
Instructions for Birth Certificate Order Form
Carefully read these instructions before completing and submitting the Birth Certificate Order Form. Chapter 70.58A RCW and
Chapter 246-491 WAC requires all applicants to be a qualified applicant, provide identity and proof of eligibility documentation, and
provide required information to order a birth certificate.
Checklist for completing the Birth Certificate Order Form:
Complete all fields on the birth certificate order form, sign, and date
A copy of your identity document(s)
A copy of your proof of eligibility document(s)
Check or money order made payable to King County Vital Statistics
Send the order form, all documents, and nonrefundable payment to:
King County Vital Statistics
Mailbox 359784
325 Ninth Ave
Seattle, WA 98104-2499
What is a qualified applicant?
A qualified applicant is a person who is eligible to receive a certificate.
Who are the qualified applicants for a birth certificate?
Qualified applicants for a birth certificate are: Self, Spouse/Domestic Partner, Child, Parent, Stepparent, Stepchild, Sibling,
Grandparent, Grandchild, Great Grandparent, Legal Guardian, Legal Representative, Authorized Representative, or Government
Agency or the Courts (only for official duties).
Are you one of the qualified applicants listed above to the birth certificate you are requesting?
If yes, continue. You will need to provide identity and proof of eligibility documentation.
**If you are not one of the listed above, STOP. You will not receive a WA State birth certificate**
What is proof of eligibility documentation?
Proof of eligibility documentation are documents that link you to the requested birth certificate.
1. If you are listed on the record and your identity documentation sufficiently links you to the record (i.e. self or parents), your
proof of eligibility requirement is met.
2. If you are not listed on the record or your identity documentation doesn’t sufficiently link you to the record, you must
provide additional documentation to prove eligibility.
What documents will King County Vital Statistics accept to prove eligibility?
King County Vital Statistics will accept the following documents to prove eligibility:
• Copies of vital records such as certifications of birth, death, marriage, and divorce from this or another jurisdiction that link
you to the requested record
• Copies of certified court orders from a court of competent jurisdiction linking you to the record (i.e. legal guardian)
• Document or letter from a government agency or courts stating the certification will be used in the conduct of official
duties (for government and court officials only)
View the Proof of Eligibility (PDF) for examples of how to prove qualifying relationship.
King County Vital Statistics
Mailbox 359784
325 Ninth Ave
Seattle, WA 98104-2499
206-897-5100
To request this document in another format, call 1-800-525-0127.
Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected]
What identity documentation will King County Vital Statistics accept?
King County Vital Statistics will accept a copy of:
• One government issued identity document (must contain photo, full name, and date of birth) that is current or expired less
than 60 days; or
• If you do not have a government issued identity document, then at least two alternate documents from the alternate list.
The alternate documents must contain matching first and last names and addresses, or in combination contains full name,
date of birth, and photograph.
View the list of acceptable identity documentation.
What information is required?
The following information is required as it appears on the birth certificate:
• First, middle, and last name of the subject of the record
• First and last name of all parents listed on the record
• Date of birth (month, date, year)
• City or county where the birth occurred
What if I cannot provide the required documents to prove eligibility, do not have identity documents from the acceptable list, or
know the required information?
If you are unable to meet the requirements, you may submit a request for an exception. This process allows the applicant to explain
why you are unable to provide the required documentation or information.
What address do I put on the order form?
The address you provide on the order form must be the address you are REGISTERED to receive mail at. If that is not an option, put
the name of the individual registered at the address and then put “in care of” before your name (Ex. John Doe C/O Jane Doe, 101
Jefferson Street, Seattle, WA 98104). If filling in the form by hand, please print clearly to avoid delay in processing.
What form of payment is accepted?
We accept checks or money orders for requests mailed to King County Vital Statistics. Make sure your check or money order is made
payable to King County Vital Statistics or KCVS.
Important note: no refunds will be given if a record could not be located or the documentation you provided did not prove you
were eligible to receive a birth certificate.
Helpful tip: To confirm that King County Vital Statistics has received your order over the phone, we need:
• For Checks: Check number, date it was cashed (check with your banking institution before calling King County Vital
Statistics), and name on the check
• For Money Orders: Money order number and date it was cashed (to find this date call the number provided on your money
order receipt)
For more information about vital records, please visit our website at https://www.kingcounty.gov/depts/health/vital-statistics.aspx.
To request this document in another format, call 1-800-525-0127.
Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected]
BIRTH CERTIFICATE
MAIL ORDER FORM
REGISTER
VALIDATION SPOT
MAIL ORDERS TO:
KING COUNTY VITAL STATISTICS
MAILBOX 359784
325 NINTH AVE
SEATTLE, WA 98104-2499
DO NOT USE ANY UNAPPROVED THIRD PARTY VENDOR
TO OBTAIN THIS FORM. DO NOT PAY A FEE FOR THIS
FORM
MAKE CHECKS & MONEY ORDERS
PAYABLE TO: KCVS
NO REFUNDS
FEES: (Check the box to select order type then enter the quantity. )
☐ Total number of CERTIFIED certificates
x
$25
=
ORDER BY MAIL: (WITH CHECK 0R MONEY ORDER)
☐ Handling Fee:
+
$4
=
ORDER BY MAIL: (USING DEBIT OR CREDIT CARD)
Handling Fee:
+
$15.50
☐ *UPS Express Mail Delivery:
(No PO Box)
+
$18.50
=
☐ USPS to AK/HI/Canada/Mexico: (No PO Box)
+
$25.50
=
CARD #: EXP:
TOTAL AMOUNT DUE
(ADD THE FEE AMOUNT + SHIPPING FOR TOTAL DUE)
FOR OFFICE USE ONLY
☐ NM
☐ NI
☐ NR
☐ SIE
☐ MD
☐ MR
☐ PP
☐ NQ
☐ IA
☐CALLED
DATE:
INITIALS:
☐EMAILED
DATE:
INITIALS:
☐LETTER SENT
DATE:
INITIALS:
OTHER:
☐ NOTATED IN WHALES
FEE#
COUNTRY:
APPLICANT INFORMATION
NAME OF PERSON/COMPANY ORDERING CERTIFICATE (S):
ADDRESS SENDING CERTIFICATE (S) TO: (STREET ADDRESS REQUIRED FOR FEDEX ORDERS)
CITY:
STATE:
ZIP CODE:
COUNTRY:
DAYTIME TELEPHONE NUMBER:
EMAIL ADDRESS:
To receive a birth certificate, you must indicate your relationship to the registrant below and
sign the sworn statement that you are authorized to receive the certificate.
SELECT
RELATIONSHIP:
☐ SELF
☐ PARENT
☐ SIBLING
☐ GREATGRANDPARENT
☐ AUTHORIZED REPRESENTATIVE
☐ SPOUSE/DOMESTIC
PARTNER
☐ STEPPARENT
☐ GRANDPARENT
☐ LEGAL GUARDIAN
☐ GOVERNMENT AGENCY
☐ CHILD
☐ STEPCHILD
☐ GRANDCHILD
☐ LEGAL REPRESENTATIVE
☐ COURTS
BIRTH RECORD DETAILS
CERTIFICATE HOLDER FIRST NAME(S):
CERTIFICATE HOLDER FULL MIDDLE NAME(S):
CERTIFICATE HOLDER LAST NAME(S):
DATE OF BIRTH:
CITY OF BIRTH:
COUNTY OF BIRTH:
COUNTRY OF BIRTH:
PARENT/MOTHER FIRST NAME(S):
PARENT/MOTHER MIDDLE NAME(S):
PARENT/MOTHER LAST NAME(S): (PRIOR TO FIRST MARRIAGE)
PARENT/FATHER FIRST NAME(S):
PARENT/FATHER MIDDLE NAME(S):
PARENT/FATHER LAST NAME(S):
I declare under penalty of perjury under the laws of the state of Washington that the information I have
provided is true and correct. Further, be advised that willfully providing a false statement to
vital records for a certificate is a gross misdemeanor under Washington law, RCW 70.58A.590(2).
SIGNATURE (APPLICANT)
DATE SIGNED: (MM/DD/YYYY)
